The present invention relates in general to a holder for a blood vessel harvested from a patient for use in cardiac bypass graft surgery, and, more specifically, to a device for assisting in sealing branch stubs and pressure testing of the blood vessel.
In coronary artery bypass grafting (CABG), a blood vessel or vessel section, such as an artery or vein, is “harvested” (i.e., removed) from its natural location in a patient's body for use elsewhere in the body. In CABG surgery, the blood vessel is used to form a bypass between an arterial blood source and the coronary artery that is to be bypassed. Among the preferred sources for the vessel to be used as the bypass graft are the saphenous veins in the legs and the radial artery in the arms.
Endoscopic surgical procedures for harvesting a section of a vein (e.g., the saphenous vein) subcutaneously have been developed in order to avoid disadvantages and potential complications of harvesting through a continuous incision (e.g., along the leg) for the full length of the desired vein section in order to provide adequate exposure for visualizing the vein and for introducing surgical instruments to sever, cauterize and ligate the tissue and side branches of the vein. One such minimally-invasive technique employs a small incision for locating the desired vein and for introducing one or more endoscopic harvesting devices. Primary dissection occurs by introduction of a dissecting instrument through the incision to create a working space and separate the vein from the surrounding tissue. Then a cutting instrument is introduced into the working space to sever the blood vessel from the connective tissue surrounding the section to be harvested and any side branches of the blood vessel. The branches may be clipped and/or cauterized.
In one typical procedure, the endoscopic entry site is located near the midpoint of the vessel being harvested, with dissection and cutting of branches proceeding in both directions along the vessel from the entry site. In order to remove the desired section of the blood vessel, a second small incision, or stab wound, is made at one end thereof and the blood vessel section is ligated. A third small incision is made at the other end of the blood vessel section which is then ligated, thereby allowing the desired section to be completely removed through the first incision. Alternatively, only the first two incisions may be necessary if the length of the endoscopic device is sufficient to obtain the desired length of the blood vessel while working in only one direction along the vessel from the entry point.
An example of a commercially available product for performing the endoscopic vein harvesting described above is the VirtuoSaph™ Endoscopic Vein Harvesting System from Terumo Cardiovascular Systems Corporation of Ann Arbor, Mich. Endoscopic vein harvesting systems are also shown in U.S. Pat. No. 6,660,016 to Lindsay and U.S. patent application publication 2005/0159764A1 in the name of Kasahara et al, both of which are incorporated herein by reference in their entirety.
After a vein is removed from the patient's body, it must be prepared for use as a bypass graft. Preparation includes ligating (i.e., closing off) each branch stub, injecting a solution into the vein under pressure to test for leaks, and otherwise inspecting the condition of the blood vessel. In the conventional procedures, branch stubs may be ligated using sutures for tying off each stub or staples may be employed for clamping off each stub. This processing of the blood vessel is normally performed by placing the blood vessel on a sterile surface over a patient's leg nearby the point from where it was harvested. Typically, two people (e.g., medical technicians, nurses) work together to hold the vein, apply a syringe of saline solution to pressurize the vessel, tie off or clip branch stubs as the vein is distended by the saline solution, and check for leaks. The prior art procedure is labor intensive and is difficult to perform on a loose, unsupported vein lying over an uneven surface. Since the amount of pressurized saline solution injected into a blood vessel is manually controlled according to the pressure being applied against a plunger of a syringe, the medical technician occasionally damages a blood vessel by over-pressurizing it. Other inadvertent damage may also occur during handling since the blood vessel is unrestrained and unprotected from other objects until such time as it is transferred to a bath of saline solution after it has been inspected by a surgeon performing the graft.